The over-arching goal of all my research activity is to develop and evaluate novel clinically-focused approaches to reduce the fear of developing chronic non-healing wounds, in particular pressure injuries (PrI). My research centers around development and implementation of interventions and technology to enhance rehabilitation, healthcare and overall quality of life for Veterans, in particular those with spinal cord injury (SCI). Active interdisciplinary clinical studies include determination of personalized PrI risk based on identification of novel biomarkers. We have found that muscle quality critically impacts both safe sitting interface pressure levels and safe sitting times. Detailed analysis of gluteal computed tomography scans has shown that persons with more than 15% intramuscular adipose tissue (IMAT) are much more likely to have recurrent PrI (p<.001) and that, circulatory levels of fatty acid binding protein 4 (FABP4) are significantly correlated (p<0.0001) with IMAT. This represents a paradigm shift in primary PrI prevention. A pending VA Merit Review project will study relevant DNA variants to facilitate earlier identification of Veterans with SCI predisposed to rapid , higher levels of IMAT deposition. Our Biomarkers for Early Identification of Pressure Injury Risk (BEIPIR) model will support effective personalized primary prevention for the most susceptible individuals within the high-risk population of Veterans with SCI. Clinical studies also include bioinformatics to support development of the SCI Bioinformatics Resource, a personalized healthcare tool for PrI prevention planning. I am leading a team including bioinformaticians and statistical experts to leverage the wealth of information from a study cohort of over 35,000 Veterans with SCI, securely housed in the VA Informatics and Computing Infrastructure, together with our established noninvasive methodology for tissue health assessment -THEToolbox (Tissue Health Evaluation Toolbox). Development and validation of the SCI Bioinformatics Resource will enable the individual Veterans? risk factor profile to form the basis for adaptive care planning based on prioritization of clinical practice guidelines factors. The SCI Bioinformatics Resource for Personalized, Proactive, Patient-driven Health care will support best practices in SCI care for primary and secondary PrI prevention. Ultimately this research will be applicable to all individuals with SCI to both enhance personal health status and quality of life and reduce healthcare costs. Current technology development studies include a VA Merit Review project to develop the next-generation patented smart Modular Adaptive Electrotherapy Delivery System (SmartMAEDS), to enable safe and smart delivery of electrotherapy outside traditional clinical settings. This translational development study will provide a strong foundation for the clinical delivery of personalized adaptive electrotherapy using SmartMAEDS, so that our Veterans will benefit from the most recent advances in wound healing science. I also lead technology development of flexSTIM, a flexible novel implanted pattern generator for dynamic intermittent gluteal stimulation (iGSTIM). The fully implanted iGSTIM system combining flexSTIM and intermuscular electrodes will enable regular exercise and weight-shifting. iGSTIM will impact fundamental challenges in PrI prevention and musculoskeletal heath for Veterans with SCI, particularly those with high level injury who cannot perform independent pressure relief and those at increased risk due to high IMAT. A VA Merit Review project is supporting further technology development and rapid translation to the market of the patent-pending modular cost-effective wheelchair cushion. Our cushion combines low-cost with high- performance; using advanced dynamic materials a modular support system is created which can be customized for individual seating requirements at very low cost. The cushion can be repaired rather than replaced since components are removable, thus increasing durability. This project impacts the cost of effective wheelchair cushions and PrI risk for wheelchair users, particularly Veterans with SCI.